Each year, many older adults come to an Emergency Department (ED) with injuries purportedly related to a fall or other accidents. However, we know that many of these injuries are the result of elder abuse and neglect. This ED visit presents a key opportunity for elder abuse to be detected, to have evidence collected, to report to the authorities, and to initiate appropriate interventions, yet emergency physicians receive little training in elder abuse and have few tools to assist them in detecting abuse. More →
NYCEAC’s Multidisciplinary Teams (MDTs)
Financial exploitation. Physical abuse. Psychological Abuse. Abandonment. Neglect. All are aspects of elder abuse, increasingly common nationwide, with over 120,000 older adults victimized in their own homes each year in NYC alone – and with 96% of these cases going unreported. The cases are heartbreaking and complex, requiring innovative solutions. Evidence exists that a collaborative response improves the effectiveness of agency responses and efficiently utilizes scarce resources.1
Consequently, the NYC Elder Abuse Center (NYCEAC) has focused on developing and implementing successful multidisciplinary teams (MDTs) throughout NYC. These teams represent a highly collaborative endeavor; they regularly bring together professionals from diverse fields (e.g., social work, medicine, law, nursing and psychiatry) and systems (e.g., criminal justice, health care, mental health, adult protective services, aging network). The teams review, discuss and coordinate cases of elder abuse and neglect and identify systemic and resource problems that can be brought to the attention of others for strategizing and intervention. Additionally, MDTs serve as an important informational resource for professionals working in the health, mental health, public safety, justice/legal, victim assistance and social service systems.
NYCEAC now coordinates and facilitates three multidisciplinary teams, two in Manhattan and one in Brooklyn. The first Manhattan-based team, Elder Abuse Case Coordination and Review Team (EACCRT), was launched in 2006; the Brooklyn MDT (BMDT) was launched in 2010; and the Manhattan Enhanced MDT (EMDT) was launched in 2013.
NYCEAC’s Three MDTs: Commonalities and Differences
The chart below summarizes the commonalities and differences of NYCEAC’s three teams:
NYCEAC’s MDTs: Commonalities and Differences
|Team Name||Review, Discuss Cases||Coordinate Cases||Identify System & Resource Problems||Provide Info on Resources||Geriatrician
||Geropsych & Forensic Accountant||Bank Rep||Evaluation||Meetings|
|EACCRT||X||X||X||X||X||5x/year; Voluntary Attendance|
|EMDT||X||X||X||X||X||X||X||X||2x/mo; Required Attendance|
|BMDT||X||X||X||X||X||X||3x/mo; Required Attendance|
As the chart suggests, all of the MDTs offer a central response point for the agencies and people working on elder abuse cases in the community. Professionals throughout Brooklyn and Manhattan have an opportunity to present complex elder abuse cases to the MDTs to receive recommendations on assessment and interventions from the teams. To facilitate the flow of cases to the teams, NYCEAC staff and team members conduct orientations on the MDTs – their goals, structure and intake processes – so that professionals will understand how to access the teams’ services and how best to present cases to the teams. All cases are triaged through NYCEAC’s Multidisciplinary Team Coordinator.
Both the BMDT and the EMDT have representatives from the following organizations assigned to them: DA’s Office, JASA, NYC Elder Abuse Center, NYC Department for the Aging, NYC Human Resources Administration Adult Protective Services, The Brookdale Center for Healthy Aging, The Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale, and Weill Cornell Medical College’s Division of Geriatrics and Gerontology. Since attendance at EACCRT is voluntary, representation at each meeting varies, although typically the above agencies send representatives to those meetings. In addition, EACCRT tends to have representatives attend from a wide range of community agencies as well.
The teams differ in the frequency of the meetings, focus of cases and representation. The Enhanced MDT meets twice a month and only works on cases with a financial exploitation element (although will also respond to co-occurring abuses on those cases). It is “enhanced” with forensic accountants and a geropsychiatrist. The forensic accountants, paid for through the grant, are Manhattan DA employees and will help investigate cases being brought to the team’s attention but not being prosecuted. (The geropsychiatrist’s role on the team was explained previously.) The team will be evaluated by a federally-funded evaluation team selected by Health and Human Services to understand the value of utilizing forensic accountants on financial exploitation cases in terms of finances restored and prevention of financial loss. In addition, HSBC bank sends representatives to the meetings to help the team understand how to work with the financial industry.
Although the three teams are designed differently, they all offer a central response point for the agencies and people working on elder abuse cases in the community. In addition, they utilize a case consultation model to improve the health and quality of life for older adults. This is accomplished through reviewing, discussing and coordinating cases of elder abuse and neglect; identifying systemic and resource problems that can be brought to the attention of others for strategizing and intervention; and identifying research needs.
Understanding the importance and impact of the features outlined above can be difficult without seeing the teamwork in action. With this in mind, in May 2014, EACCRT was filmed discussing a mock elder abuse case to capture the ways in which these diverse systems and professionals collaborate on complex cases:
In-Service Training on Accessing the MDTs
The NYC Elder Abuse Center’s staff and team members conduct orientations on the MDTs – their goals, structure and intake processes – so that professionals will understand how to access the teams’ services and how best to present cases to the teams. Click here for more information about these training opportunities.
Support for MDT Facilitators
NYCEAC facilitates a monthly phone-based peer leadership support group for facilitators of long-standing and nascent MDTs, and for those thinking about forming an MDT. For more information about this peer leadership group, contact Risa Breckman at firstname.lastname@example.org.
- Wiglesworth, A, Mosqueda, L, Burnight, K et. al. Findings from an elder abuse forensics center. The Gerontologist 2006; 46:277-283. [↩]